Requirements for all waiver providers

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1. APD Course Requirements for all Waiver Providers

2. Course Sections Medicaid Waiver Information. Key Provider Requirements and Best Practices Compliance with Federal and State Laws Zero Tolerance Overview Incident Reporting Medication Administration and Behavior Emergency Procedures Overview Key Contacts

3. Core Competencies Medicaid Waiver Information Section 1

4. Medicaid

5. What is a Medicaid Waiver? Medicaid Waiver

6. HCBS Federal Rule

7. iBudget

8. iBudget

9. Eight Service Families in iBudget Service Family 1 Life Skills Development Service Family 2 Supplies and Equipment Service Family 3 Personal Supports Service Family 4 Residential Services Services

10. Eight Service Families in IBudget Cont’d Service Family 5 Support Coordination Service Family 6 Therapeutic Supports and Wellness Service Family 7 Transportation Service Family 8 Dental Services Services

11. Key Provider Requirements and Best Practices Section 2

12. http://portal.flmmis.com/ iBudget Handbook

13. Enrollment

14. Enrollment http://apdcares.org/providers/enrollment/

15. Provider Types Solo Agency Group (WSC Agencies Only)

16. Solo Provider

17. Agency Providers Business or organization with two or more employees providing waiver services, including the owner Provider that hire subcontractors only to perform waiver services cannot bill at the Agency rate Bills at the Agency rate Agency Providers

18. Qualifications

19. iBudget

20. Medical Necessity Ensures Medicaid service meets the individual’s need Ensures services are consistent with rules State and federal Medicaid requirement

21. Billing Requirements Providers cannot bill when clients are not in attendance unless noted in the description of the service Providers cannot bill for more than one service to the same client at the same time unless authorized by APD Providers must render service in accordance with their service authorizations

22. A Provider must Supervise the provision of, and be responsible for, goods and services that: Have been provided to the recipient by the provider prior to submitting the claim Provider is licensed, certified, or enrolled to provide the service The service is medically necessary The provider ensures the quality of services Billing Requirements

23. Providers must ensure that the claims are: Billing Requirements

24. Billing Requirements

25. Medicaid Handbooks http://portal.flmmis.com/

26. Service Authorization Providers must have a service authorization to bill for iBudget Waiver Services. Service authorizations identify the provider, amount, duration, scope, frequency, and intensity of service.

27. Support Plan

28. Support Plan Person Centered Planning The Provider will: Implement person-centered supports and services Support development of informed choices Enhance service delivery Make improvements in the provider’s service delivery system

29. Documentation

30. MWSA

31. Self Assessment What is a Provider Self Assessment? Evaluation completed by the provider reviewing organization capabilities for meeting Client outcomes or goals and the service requirements Includes review of internal policies and procedures Provider can ensure quality services

32. Section 3 Compliance with Federal and State Laws

33. Chapter 393, F.S. Florida Statutes http://www.leg.state.fl.us

34. Bill of Rights The Bill of Rights for Persons with Developmental Disabilities

35. SS Bill of Rights The Bill of Rights for Persons with Developmental Disabilities

36. Bill of Rights The Bill of Rights for Persons with Developmental Disabilities

37. Title 42, Code of Federal Regulations Rehabilitation Act of 1973 Title VI of the Civil Rights Act of 1964 The Americans with Disabilities Act (also known as the ADA) Chapter 760, Florida Statutes is known as the Florida Human Relations Act Other Regulations

38. Legal Representative

39. Zero Tolerance Section 4 A statewide initiative to end abuse, neglect & exploitation

40. Zero Tolerance

41. Zero Tolerance Known or suspected abuse, neglect, or exploitation must also be reported immediately to the Florida Abuse Hotline at: 1-800-96-ABUSE (1-800-962-2873) TDD Access 1-800-453-5145

42. Zero Tolerance Sexual activity between a direct service provider or employee and a person with a developmental disability (to whom services are being rendered) is a crime.

43. Section 5 Incident Reporting

44. Incident Reporting What is an Incident? An incident is an occurrence which could potentially impact the health, safety and well-being of a client of APD and must be reported to APD.

45. Providers are responsible for reporting incidents involving APD clients to the Region office as they occur, but no later than the next business day. Providers must report incident reports and follow up reports to the APD Regional office. Incident Report and Follow up Form: www.apdcares.org/providers/incident-reporting/ Providers must take immediate action to the resolve the situation. Incident Reporting

46. Categories Examples of Critical and Reportable Incidents

47. Critical Incidents Unexpected Client Death Unexpected client death that occurs due to an accident, act of abuse, neglect or other unexpected incident. Examples: Homicides Motor Vehicle Accidents Accidental Drug Overdoes Heart Attack, Stroke, Trauma Sudden death Rapid deterioration

48. Critical Incidents Life Threatening Injury Severe Injuries Substantial Risk of Death Loss of or substantial impairment of body

49. Critical Incident Sexual Misconduct Any sexual activity between a client and provider is sexual misconduct, regardless of whether the client consented. Other incidents of nonconsensual sexual activity between clients or others is also sexual misconduct.

50. Critical Incident Missing Child or Adult Who Has Been Adjudicated Incompetent Missing for more than one hour Please provide a case number from law enforcement in the Incident Report

51. Critical Incident Media Involvement Unusual occurrence with unfavorable media attention Client Arrest Arrest of a client due to a violent crime Verified Abuse, Neglect, or Exploitation Always report any circumstance where the Department of Children and Families verifies Abuse, Neglect, or Exploitation by the provider or staff of a provider.

52. Expected Client Death Death a result of long-standing or progressive medical condition May be age-related Altercation Physical confrontation between either: - Client and member of community Client and provider Two or more clients while services are rendered Reportable Incidents

53. Client Injury Non-life threating injury received during service provision May be due to an accident, act of abuse, neglect, or other incident while receiving services Reportable Incident

54. Missing Competent Adult – Absence or unknown whereabouts beyond eight hours of a legally competent adult receiving services from a provider. Suicide Attempt- Physical attempt by a client to cause his or her own death Baker Act – Involuntary admission of a client for involuntary examination or placement for psychiatric care Reportable Incident

55. Non-violent Crime Arrest – Arrest of a client for a non-violent crime while under the direct care of a provider. Reportable Incident

56. Section 6 Overview of Medication Administration and Behavior Emergency Procedures

57. 65G-7 Rule

58. Reactive Strategies Reactive strategies are the procedures or physical crisis management techniques of seclusion or manual, mechanical, or chemical restraint utilized for control of behaviors that create an emergency or crisis situation. Rule 65G-8 of the Florida Administrative Code

59. Reactive Strategies Protects clients from unnecessary restraint and seclusion Requires training Prevents the use of reactive strategies when not medically safe and identifies who can authorize them Limits or prohibits certain procedures Requires documentation and reporting Rule 65G-8 of the Florida Administrative Code

60. Section 7 Key Contacts

61. Regional Offices http://apdcares.org/region

62. Contacts Provider Enrollment [phone]-Option 4 ( 8 a.m. – 5 p.m. ET) Web Portal Password Reset [phone]- Option (7:30 a.m.- 6 p.m. ET) http://portal.flmmis.com/flpublic

63. Congratulations! You have completed the Requirements for all Waiver Providers Course My signature on this certificate acknowledges that I viewed the “Requirements for all Waiver Providers” course. ______________ ______________ Name Date Certificate of Completion